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Permit
41 CITY O 1 TIGARD GARD ELECTRICAL PERMIT PERMIT #: ELC2004 -00793 DEVELOPMENT SERVICES DATE ISSUED: 12/13/2004 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - 4171 PARCEL: 2S103DB -06800 SITE ADDRESS: 11180 SW EDEN CT SUBDIVISION: GENESIS NO. 3 ZONING. R-4.5 BLOCK: LOT : 053 JURISDICTION: TIG Project Description: Installation of gas furnace, (Circuit is on equipment side of disconnect). RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS 1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION: EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG: LIMITED ENERGY: 401 - 600 amp: SIGNAL /PANEL: MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10): SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS 0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION: 201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR: 401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT: 601 - 1000 amp: PLAN REVIEW SECTION 1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL: Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC: Owner: Contractor: BUSHNELL, GEORGE H JR + PIONEER GAS FURNACE CHARLOTTE C 3615 NE BROADWAY 11180 SWEDEN CT PORTLAND, OR 97232 TIGARD, OR 97223 Phone: 503 - 670 -8516 Phone: 503 - 249 -5000 Reg #: ELE 22- 177LHR LAC 36102 FEES Description Date Amount Required Inspections [ELPRMT] ELC Permit 12/13/200' $46.85 [TAX] 8% State Surcharge 12/13/200' $3.75 Rough -in Elect] Final Total $50.60 This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other applicable laws All work will be done in accordance with approved plans This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100 You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699 or 1 -800- 332 -2344 Issued By: Permit Signature: 4 c?1\‘ OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease, or rent. OWNER'S SIGNATURE: DATE: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N: DATE: LICENSE NO: Call 639 -4175 by 7:00pm for an inspection the next business day Elect - neat Permit Application FOR ra l• I Si: ONl.\ Gity o T BECEIVE0 Date/By 1 3 G� 6 � - j iU y 1 �/ I omit No 13125 SW Hall Blvd., Tigard, OR 972 Plan Review Phone 503.639 -4171 Fax 503 598.1960 / ' 1410 f ` Date /By Other I'enmt Inspection Line: 503.639 4175 DEC ° 1 20 t, - ; s "' I, , ® Dale Ready / By Mos See Page 2 for Internet: www ci tigard or us t Notified/Method 1 , Cr Supplemental Information . a • TY ' F I I. PLAN REVIEW MLI ❑ New construction A I r a tern ton / pTacement Please check all that apply ❑ Demolition ❑Other: ❑Service over 225 amps, cumin] ❑f Hazardous location ['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft., CATEGORY OF CONSTRUCTION of I and 2 family dwellings 4 or more new residential VI I - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building ['System over 600 volts nominal units in one structure ['Building over three stories ['Feeders, 400 amps or more ❑ Multi - family 0 Master builder 0 Other: ❑Occupant load over 99 persons ❑Manufactured structures or JOB SITE INFORMATION AND LOCATION ❑Egress/lightmg plan RV park /' / SO Stk� r � - ❑l Health -care facility ['Other Job no.: nob site address: r Submit 2 sets of plans with any of the above City /State /ZIP: Ti ,r D e_ 9 7223 The above arc not applicable to temporary construction service 1 & FEE* SCHEDULE LE I l Suite/bldg. /apt. no.: Protect name: Description Qty. Fee. Total Cross street/directions to job site: New residential single - or multi - family dwelling unit. -- Includes attached garage. r 1,000 sq R. or less 145 15 I 1 4 Subdivision: - lot no.: Ea add] 500 sq R. or portion 33.40 1 Limited energy, residential 75 00 2 Tax map /parcel no.: Limited energy, non - residential 75 00 2 • DESCRIPTION OF WORK Each manufactured or modular / s�Vi * t dling, ll 2 k Q[ / C(S ri /c.cC e e/ rezt,t'-I G�� ^nvrtne a Lt.Iortti Service or service feeders anu installation feeder , alteration , and /or 90 relocation AH f's a • V / W�/I!Y S'I ''Cre 6 � S Lc y � ❑ PROPE ' i ' OWNER C ❑ J TENANT CJ 200 amps or less 80 30 2 201 amps to 400 amps 106 85 2 6,4,61,-q 401 amps to 600 amps 160.60 2 Name: e 8 „ 601 amps to 1,000 amps 240.60 2 • Over 1,000 amps or volts 454 65 2 a- Reconnect only --- 6 85 I 2 City /State /ZIP: Temporary services or feeders installation, alteration, and /or "� ) 1 Fax: ( ) relocation Phone: ( J (�� K 7g �) �II 200 amps or less 66 85 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100 30 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133 75 ' 2 Owner signature: . - Date: Branch circuits - new, alteration, or extension, per panel ❑ APPLICANT ❑ CONTACT PERSON A Fee for branch circuits with service or feeder fee, each 6 65 2 Business name: branch circuit — B Fee for branch circuits Contact name: without service or feeder fee, I 46.85 dr $5 2 each branch circuit �2 Address: Each add'I branch circuit 6.65 2 City /State /ZIP: Miscellaneous (service or feeder not included) Pump or irrigation circle 53 40 2 Phone:( ) Fax :( ) Sign or outline lighting 53 40 2 E -mail: Signal circuit(s) or limited - CONTRACTOR energy panel, alteration, or 1 extension Describe Page 2 2 Business name: P.tb h ee r aS' re rria e_ e Address: 36/ 5 /VE 6r-- Each additional inspection over allowable in any of the above Per inspection 62 50 City /State /ZIP: Pc, r / /a / ©R 97232. Investigation per hour ti hr min) 62 50 Phone: ( 249 5000 Fax: (5.03 249 826,0 Industrial plant per hour 73.75 (.C .7 ELECTRICAL PERMIT FEES* CCB Lie.: 3 6 /Q Z Electrical Lie.: 22-177 L ic.: Subtotal 4 / - LP Suprv. Electrician signature, reyuired:/ G� �0 . Plan review (25% of permit fee) —.--- . Print name: obr e t/�C.J 2 Date:/ n ....9...0 ( Q State surcharge (8% of permit fee) 2� TO'IAI. PERMIT FEE 50 .6)D Authorized signature: a , This permit application expires if a permit is not obtained within 180 Gam days after it has been accepted as complete Print name: Date: /2 4-0 ,!L * Fee methodology set by TI - County Building Industry Service Board ( ** Number of inspections per permit allowed Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RES IDENTIAL WORK ONLY: Fee for all residential systems combined........ $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: O 1_1 .ItCIIALMORK O $75.00 . Fee-for each commercial system (SEE OAR 918 260 - 260) • Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation • Fire Alarm Installation ❑ HVAC ❑ instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations V ® ® © %,A B ® U Bn 01'l 44.E —I • VW.," BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: § (503) 639 -4171 MST BUP Received h / Date . equested / / ' AM PM BUP Location / // ,) '7. — (� , 1 Suite MEC � �� Contact Person '. (/)Z ) PLM Contractor • h ( ) / "' BUILDING Tenant/Owner L ' / s ii. , V •"6 � 7 C Footing - C Foundation Access: pi L 'vL // 6 - - `'= , '`" Ftg Drain , syr ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath /Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof ' Other: Final PASS PART FAIL PLUMBING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final PAS FAIL CHANICA - {` .. ` Pos ea Rough -In , /,+ l" } 1 Gas Line '' -- Smoke Dampers li 4 al z s xf S � PART FA CTR ,, Service � " ilo Rough -In ` �. UG /Slab 1 ,t i Tr ° a *.- Q Low Voltage ,-, ,- � ice ,, ` Fina SS ART FAIL n Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. n Please call for reinspection RE: n Unable to inspect - no access r, , Fire Supply Line I • Approach /Sidewalk Date 1 2. 2 / , Inspector g - Alb �'� Ott Other: Final DO NOT REMOVE this inspection record from the ) ®h site. PASS PART FAIL